Comparison of Four Risk Assessment Tools for Postpartum Pharmacologic Thromboprophylaxis
American Journal of Obstetrics and Gynecology
OBJECTIVE: Multiple risk assessment tools (RAT) exist to determine which patients should receive postpartum pharmacologic thromboprophylaxis but one model has not been shown to be superior than another. Our objective is to compare the ability of four RATs in identifying high-risk patients who require postpartum pharmacologic thromboprophylaxis. STUDY DESIGN: We conducted a retrospective chart review of postpartum venous thromboembolism (VTE) cases after delivery hospitalizations from October 2016 to September 2019 at two tertiary care Beaumont Hospitals. Postpartum VTE cases were identified through ICD-10 codes and verified as occurring within 125 days of delivery. Four RATs were retrospectively applied to the postpartum VTE cases to determine the proportion of patients that stratified as high risk to qualify for postpartum pharmacologic thromboprophylaxis. RESULTS: Out of 31,445 delivery hospitalizations, 48 postpartum VTE cases were identified for an incidence of 0.15%. The average number of days from delivery hospitalization to VTE diagnosis was 27.7 (+/- 28.8). Of the 48 cases, 23 underwent cesarean delivery (CD) and 25 underwent spontaneous vaginal delivery (SVD). The California Maternal Quality Care Collaborative (CMQCC) RAT stratified 41.7% of the VTE cases as high risk for postpartum VTE. The National Partnership of Maternal Safety (NPMS) consists of a modified Padua and Caprini RAT for SVD and CD respectively and classified 52.1% of cases as high risk. The Royal College of Obstetrics and Gynecology (RCOG) RAT stratified the most patients as high risk with 75%. The American College of Chest Physicians (ACCP) stratified 82.6% of post-CD patients as high risk, whereas NPMS and RCOG RATs stratified 100% as high risk. CONCLUSION: In this cohort, more patients developed a postpartum VTE after delivery hospitalization for SVD than compared to CD. Furthermore, the RATs performed poorly in the post-SVD subgroup when compared to the post-CD subgroup. Additional study is needed to optimize postpartum thromboprophylaxis protocols.
Sajja S, Alpay-Savasan Z. Comparison of four risk assessment tools for postpartum pharmacologic thromboprophylaxis. Am J Obstet Gynecol. 2023 Jan;228(1 Suppl.):S742. doi:10.1016/j.ajog.2022.11.1238